Surgery for Renal Cell Carcinoma, Vital Role of Cardiopulmonary Bypass: Case Report

Renal cell carcinoma has a high potential for tumor and thrombus extension into the renal veins, inferior vena cava and even the right atrium. Surgical excision of the tumor and the thrombus is challenging and may require cardiopulmonary support. In this case report, we present successful surgical treatment of two renal cell carcinoma cases with thrombi in their inferior vena cava, one also having an intracardiac involvement. Cardiopulmonary bypass and total circulatory arrest was necessary in the second patient. Especially in high levels of renal cell carcinoma exten- sion, very careful handling of the related organs and vasculature is essential to minimize the risk of pulmonary embolization. While simple venotomy/cavotomy after clamping may be enough in so- me cases, cardiopulmonary bypass may be life-saving especially in stage 3 and 4 tumors, or in cases where intraoperative massive pulmonary embolization occurs. Thus, a multidisciplinary approach with cardiopulmonary bypass standby is necessary for a successful surgery.